Investigation of a Multi-Drug Resistant  Klebsiella pneumoniae  Outbreak in a Cardiac Surgery Intensive Care Unit (CSICU)

Background: Klebsiella pneumoniae infection is responsible for a wide range of infections including pneumonia, bacteremia, wound infections, and urinary tract infections. Objective: To investigate and manage the occurrence of multi-drug resistant Klebsiella pneumoniae outbreak in Intensive Care Unit of Tanta University Emergency Hospital. Methodology: The investigation of the outbreak included isolates identification and typing while management included implementation of infection prevention and control precautions; establishment of an Outbreak Control Team; epidemiological investigations; and decontamination of environment. Results: During September 2020, five patients in the Intensive Care Unit in Emergency Hospital of Tanta University had multi drug-resistant Klebsiella pneumoniae identified in samples obtained from a variety of specimens. The fifth case was identified 10 days following confirmation of the first case. The Microbiology laboratory confirmed the five cases had identical Klebsiella pneumoniae strains. This suggests that there was a patient-to- patient spread of multidrug resistant Klebsiella pneumoniae. Conclusion: This investigation revealed the importance of proactive recognition of a possible outbreak, screening of patients transferred from other hospitals, early identification of any unusual microorganisms and implementation of early infection control interventions.

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Changing Characteristics and In Vitro Susceptibility to Ceftazidime/Avibactam of Bloodstream Extensively Drug-Resistant Klebsiella pneumoniae from a Greek Intensive Care Unit

Microbial Drug Resistance ◽

10.1089/mdr.2019.0090 ◽

2020 ◽

Vol 26 (1) ◽

pp. 28-37 ◽

Cited By ~ 2

Author(s):

Angeliki Mavroidi ◽

Maria Katsiari ◽

Sofia Likousi ◽

Eleftheria Palla ◽

Zoi Roussou ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Drug Resistant ◽

In Vitro Susceptibility ◽

Extensively Drug Resistant

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Characterization of Extensively Drug-Resistant or Pandrug-Resistant Sequence Type 147 and 101 OXA-48-Producing Klebsiella pneumoniae Causing Bloodstream Infections in Patients in an Intensive Care Unit

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02457-17 ◽

2018 ◽

Vol 62 (7) ◽

pp. e02457-17 ◽

Cited By ~ 19

Author(s):

Kalliope Avgoulea ◽

Vincenzo Di Pilato ◽

Olympia Zarkotou ◽

Samanta Sennati ◽

Leda Politi ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Sequence Type ◽

Snp Analysis ◽

Drug Resistant ◽

Pfge Profile ◽

Content Type ◽

Extensively Drug Resistant ◽

Insertional Inactivation

ABSTRACT Carbapenem-resistant Klebsiella pneumoniae causes important health care-associated infections worldwide. An outbreak of sequence type 11 (ST11) OXA-48-producing K. pneumoniae (OXA-48-Kp) isolates occurred in Tzaneio Hospital in 2012 and was contained until 2014, when OXA-48-Kp reemerged. The present study involved 19 bloodstream infection (BSI) OXA-48-Kp isolates recovered from 19 intensive care unit (ICU) patients hospitalized between August 2014 and July 2016. MICs were determined by broth microdilution. Beta-lactamase genes were detected by PCR. All isolates were typed by pulsed-field gel electrophoresis/multilocus sequence typing (PFGE/MLST), and 10 representative isolates were typed by next-generation sequencing (NGS). Of the 19 study patients, 9 had previous hospitalizations, and 10 carried OXA-48-Kp prior to BSI isolation; median time from ICU admission to BSI was 29 days. Four OXA-48-Kp isolates belonged to PFGE profile A (ST147) and were pandrug resistant (PDR), while 15 isolates exhibited PFGE profile B (ST101) and were extensively drug resistant. Genes detected via NGS resistome analysis accounted for most of the resistance phenotypes, except for tigecycline and fosfomycin. Insertional inactivation of mgrB (distinct per clone) conferred colistin resistance in all 19 isolates. NGS single nucleotide polymorphism (SNP) analysis validated the clonal relatedness of the ST147 and ST101 strains and revealed the possible presence of two index ST147 strains and the microevolution of ST101 strains. Distinct, but highly related, IncL OXA-48-encoding plasmid lineages were identified; plasmids of the ST147 strains were identical with the plasmid of ST11 OXA-48-Kp which caused the 2012 outbreak. In conclusion, biclonal circulation of OXA-48-Kp and, alarmingly, emergence of a PDR clone are reported. These observations, along with the challenging phenotypic detection of OXA-48 producers and the high reported transmissibility of blaOXA-48, necessitate intensive efforts to prevent their further spread.

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Role of Environmental Surfaces and Hands of Healthcare Workers in Perpetuating Multi-Drug Resistant Pathogens in a Neonatal Intensive Care Unit

10.21203/rs.3.rs-252790/v1 ◽

2021 ◽

Author(s):

Marwa A. Elkady ◽

Wafaa M.K. Bakr ◽

Hesham Ghazal ◽

Eman A. Omran

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Neonatal Intensive Care Unit ◽

Healthcare Workers ◽

Neonatal Intensive Care ◽

Late Onset ◽

Drug Resistant ◽

Environmental Surfaces ◽

Increased Risk

Abstract Neonates admitted to neonatal intensive care units are at a risk of developing healthcare associated infections, leading to increased risk of mortality. This study aimed to identify organisms causing such late-onset infections in neonates and determine whether these isolates were genetically identical to those from the surrounding environmental surfaces and hands of healthcare workers (HCWs). A cross-sectional study was carried out over a period of four months in a University neonatal intensive care unit. Samples were collected from all neonates with symptoms of late-onset infections (n=180). Fingerprint samples of 21 healthcare workers as well as 330 random environmental samples were also taken from the unit. Isolates from neonates, environment and fingerprints were subjected to protein electrophoresis followed by sequencing to detect genetic similarities. Almost half of neonatal samples were culture-positive (91/180, 50.6%), out of which, 72% of bacterial isolates (49/ 68) were multi-drug resistant. Klebsiella pneumoniae (32.6%) and Candida spp. (28.4%) were the commonest neonatal isolates. A cluster of four homologous Klebsiella pneumoniae strains was isolated from two neonates as well as an examining bed and a portal incubator. Another cluster was isolated from hands and three neonatal samples. Both clusters were multi-drug resistant Klebsiella pneumoniae. A homologous pair of each of Candida tropicalis and Candida glabrata was isolated from the blood of two neonates, and one neonatal and a crash cart sample, respectively. Overall, 8.8% (8/91) of neonatal samples were found to be homologous to other neonatal /environmental/ hand isolates, denoting perpetuation of pathogens between neonates themselves and also other reservoirs of infections. Conclusion: Hands of healthcare providers as well as surfaces are reservoirs of multi-drug resistant pathogens in the neonatal intensive care unit.

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